Proposed Anesthesia Scoring Criterias for Video Assisted Thoracic Surgery at

Lung Center of the Philippines

Submitted by:
Surgical Intensive Care Unit/Post-Anaesthesia Care Unit/Operating Room

Allan Flores, RN

Dahlia Galinato, RN

Nurse II

Nurse II

Lourdes Liza Sales, RN

Nurse II

Adviser:
Rosario M. Cristi, RN
Nurse IV

Co-advisers:

Zenaida B. Gaspe, RN

Marilyn A. Aro, RN

SICU/PACU Head nurse

OR Head nurse

APPROVAL SHEET

Rosario M. Cristi RN
Adviser

Approved by the Committee on Oral Examination with the grade of _________.

Glenda L. Picardal RN, MAN, MM, MPA, PhD

Division Chief II Nursing Training and Research Division

Elvira N. Baura RN, MAN

Department Manager II Nursing Service

ACKNOWLEDGEMENT
This study is sincerely dedicated to our patients who underwent Video Assisted
Thoracic Surgery who was discharged safely at the Post-Anaesthesia Care Unit. To the
Anaesthesiologist and nurses that gave their best to render high quality service.
We would like to extend our deepest gratitude to the following:
Our adviser, Theresa Alcantara, MD, who continuously guides and boosts our morale
during the research.
Our in-house adviser, Rosario M. Cristi RN, for tirelessly lending us a hand in every
step of the way.
Our head nurses, Mrs. Zenaida Gaspe, RN and Mrs. Marilyn A. Aro RN, who keeps
on finding ways to adjust the staffing in order to give way to our schedule.
To the Nursing Training and Research Staff headed by Ms. Glenda Picardal RN,
MAN,MM, MPA, PhD, Mrs. Edna Formaran RN, MAN, Mr. Leonardo Macaraan, RN
and Emmanuel Caab Jr. RN, for their unwavering patience and understanding.
To our fellow staff from Surgical Intensive Care Unit, Post Anesthesia Care Unit
and Operating Room for giving insights and enthusiastically participating in our research.
To the Lord Almighty for giving the strength, knowledge and confidence in our
endeavour.

DEDICATION

This study is sincerely dedicated to our patients who underwent Video Assisted
Thoracic Surgery who were discharged safely at the Post-Anaesthesia Care Unit. To the
Anaesthesiologist and Nurses who gave their best to render high quality service.

TABLE OF CONTENTS

Title Page 1
Approval Sheet 2
Acknowledgement . 3
Table of Contents ....... 5
List of Table and Figures ........7
Chapter I

The Problem and Its Background 8

Introduction
Statement of the Problem
Significance of the Study
Scope and Delimitation of the Study
Hypothesis
Conceptual Framework
Paradigm of the Study
Definition of Terms
Chapter II

Review of Related Literature and Studies .. 13

Chapter III

The Research Design .. 15

Methods of Research
Respondents
Setting
Research Proceedings and Instruments
Statistical Treatment
Chapter IV

Presentation, Analysis and Interpretation ..... 23

Chapter V

Summary, Conclusions and Recommendations .. 33

Summary
Conclusion

Recommendations
Bibliography
Appendices
Curriculum Vitae

LIST OF TABLES
Tables
1

Assessment of Nurses on the Over-All Condition of Patients in PACU Based on

Post-Anaesthesia Scoring System Four Hours after Video Assisted Thoracic
Surgery.

Assessment of Nurses on the Condition by Criteria of Patients in PACU based on

Post-Anaesthesia Scoring System Four Hours after Video Assisted Thoracic
Surgery.

Assessment of Nurses on the Over-All Condition of Patients in PACU Based on

Post-Anaesthesia Scoring System Eight Hours after Video Assisted Thoracic
Surgery.

Assessment of Nurses on the Condition by Criteria of Patients in PACU Based on

Post-Anaesthesia Scoring System Eight Hours after Video Assisted Thoracic
Surgery.

Assessment of Doctors on the Over-All Condition of Patients in PACU Based on

Post-Anaesthesia Scoring System Eight Hours after Video Assisted Thoracic
Surgery.

Assessment of Doctors on the Condition by Criteria of Patients in PACU Based

on Post-Anaesthesia Scoring System Eight Hours after Video Assisted Thoracic
Surgery

Summary of Persons r-Coefficient of Correlation Test Result to Determine the

Significant Relationship Between the Nurses and Doctors Assessment on the
Condition of Patients in PACU

CHAPTER I
THE PROBLEM AND ITS BACKGROUND
Introduction:
The impetus for this research was to have a good post anesthesia scoring
criteria because since time immemorial Lung Center of the philipines, the post
anesthesia care unit dont have any criteria on how to discharge patient. The intent
of this research was to improve the flow of patients through the recovery process,
in an effort to contain or reduce cost while still maintaining high quality patient
care standards, thus it shown a decreased in patient length of hospital stay
without increase in reports of post-operative complications. The favourable
outcomes of the use of this scoring have led to its implementation after a protocol
discussion.
The time immediately following a general anaesthetic. Is a critical period for
patients recovery, requiring intensive observation to enable early detection of
complications from surgery. Since its introduction in 1923, the Post Anaesthesia
Care Unit is the preference location for the immediate recovery to the Post
Operative Patient. The patient length of stay in Post Anaesthesia Care Unit is
dependent upon a number of factors, including pre-operative health status,
surgical procedure, type of anaesthetic and the stability of vital signs. It has been

common practice for PACU discharge policies to stipulate a minimum length of

stay with a patient readiness for discharge traditionally relying upon nursing
relying assessment of normality and stability of physiological parameters.
A patient condition can deteriorate quickly and much work has been carried
out to develop tools to assist the identification of deteriorating vital signs.
Utilization of such tools has been associated with a reduction in adverse events in
ward. Based since advent of day procedure surgical units there has been an
increasing trend towards the use of similar objective scoring systems to aid
decision making and quality patient readiness for discharge from PostAnaesthesia Care Unit.
Post-Anaesthesia assessment guidelines are often focused on the rule of an
Anaesthesiologist, however due to nurse central role in the management of
patience in the Post-Anaesthesia Unit setting, Anaesthesiologist often delegate the
responsibility for evaluation of patient availability for discharge to the PostAnaesthesia Care Unit nurse. Basing nursing practice an evidence is fundamental
to optimal and effective care. Even experienced nurse face a dilemma about a
right time to transfer or discharge patients.
Statement of the Problem:
The study aimed to develop a clinically based objective scoring system to
assess and to measure the readiness of patient who underwent Video Assisted
Thoracic Surgery (VATS) at Lung Center of the Philippines.
Specifically it sought to answer the following questions:
1. What is the assessment of the nurses on the condition of patients in PostAnaesthesia Care Unit based on Post Anaesthesia Scoring System four eight
hours after Video Assisted Thoracic Surgery?

2. What is the assessment of the doctors on the condition of the patients in PostAnaesthesia Care Unit based on Post Anaesthesia Scoring System eight hours
after Video Assisted Thoracic Surgery?
3. Is there a significant difference in the assessments of nurses and doctors of
patients who underwent Video Assisted Thoracic Surgery?
4. Is there a significant difference in the assessment of the nurses and doctors on the
condition of patients in post anesthesia care unit using Post anesthesia scoring
criteria four to eight hours after Video Assisted Thoracic Surgery?
Significance of the Study:
The following are deemed to benefit from the study:
1. To the institution, Lung Center of the Philippines, the study will for the
development of institutional policy on how to assess and discharged/ transfer out
patient from Post anesthesia care unit.
The Healthcare team, this study aims to develop an instrument that will serve as
basis for proper assessment to patient whether it is suitable to be discharged and
transferred to ward or to be retained in Post-Anaesthesia Care Unit.
2. The Patients/Clients will received utmost care as nurses becomes updated
and enriched with knowledge and skills on post anesthesia care unit..
3. The Family/Relatives will become satisfied with their love ones attention
and care received from health team members. They themselves will be diretly
involved in their patients management..
4. The Researchers- will conduct similar study on similar local to generate a
more expanded conclusion and recommendations.
Scope and Limitations:
The study was conducted at Lung Center of the Philippines for the period
of 2 months from July to August of 2014.The respondents are Nurses and

Anesthesiologist assigned at Post Anesthesia Care Unit and take care patients
with pulmonary disease and underwent Video Assisted Thoracic Surgery
.Excluded from the study are outside Lung Center of The Philippines non lung
center nurses and doctors and patients who underwent non thoracic surgery.
Hypothesis:
This study tested at 0.05 level of significance the null hypothesis that
there is no significant correlation between the assessment of nurses and doctors
on the condition of patients in the Post Anesthesia care unit based on post
anesthesia scoring system after video assisted thoracic surgery.
Theoretical Framework:
The Nursing Theory utilized was the Self Care Theory of Dorothea
Orem. The theory explained that nursing is an extend regulatory force that acts to
preserve the organization and integration of the client behaviour at the optimal
level those condition in which the behaviour contributes a threat to physical or
social level of health in which illness develops. Nursing has a special concern to
mans needs for self-care and action. Self-care is requirement on every person,
man, woman and child. When self-care is not maintained illness, diseases and
death will occur. The above theory is paralleled to nursing as a unique situation
and dedication in one hand. It is the product of a scientific method of analysis
which studies humans as a bio-psychosocial being on the other hand; nursing
dedication to health is forcing the profession to view humans from a holistic
point of view. This dichotomy creates frustration at times. But one basis for

uniqueness of nursing is believed to reside in viewing man from a concept of

holism to promote health.
Paradigm of the Study:

Nurses 4 to 8 hours PostAnaesthesia Scoring

Criteria Assessment of
patients who underwent
Video Assisted Thoracic
Surgery.

Doctors 4 to 8 hours PostAnaesthesia Scoring

Criteria Assessent of
patients who underwent
Video Assisted Thoracic
Surgery.

Figure I: Paradigm of the Study to Determine The Significant Difference on the

Nurses And Doctors Assessment Of Patients After Video Assisted Thoracic Surgery.

Definition of Terms:

Post-Anaesthesia Care Unit - sometimes referred to as Post-Anaesthesia Recovery (PAR)

is a vital part of hospitals ambulatory care and other medical facilities. It is an area
normally attached to operating theatre suite designed to provide care for patients
recovering from anaesthesia whether it be general anaesthesia, regional anaesthesia or
local anaesthesia.
Video Assisted Thoracic Surgery - is a type of surgery that enables doctors to view the
inside of the chest cavity after making only very small incisions. The doctor can examine
the outside surface of the lung and the inner surface of the chest wall through a camera
attached to the scope. Abnormal appearing areas on the lung surface can be biopsied.
Nurses - to which surgical patients are taken for nursing assessment and care while
recovering from anaesthesia. Vital signs, adequacy of ventilation, level of consciousness,
surgical site, and level of pain are carefully monitored as the patient recovers
consciousness.
Anaesthesiologist- is a physician trained in anaesthesia and peri-operative medicine.
CHAPTER II
REVIEW OF THE RELATED LITERATURE AND STUDIES
Postoperative patients must be monitored and assess closely for any deterioration in
condition and the relevant postoperative care plan or pathway must be implemented.
Postoperative patient are at risk of clinical deterioration, and it is vital that it is

minimised. Knowledge and understanding of the key areas of risk will help reduce
potential problem .When assessing the post-operative patients it is vital that the patient is
observed for signs of haemorrhage, shock, sepsis. and the effects of anaesthesia and
anaesthetic. Patients receiving intravenous opiates are at risk of their vital signs and
consciousness levels being compromised if the rate of the infusion is too high. It is
therefore imperative that the patients pain control is managed well, initially by the
anaesthetist and then the ward staff to ensure that the patient has adequate analgesia but is
alert enough to be able to communicate and cooperate with clinical staff in the
postoperative period. Vital signs should be performed in accordance with the policies and
compared with the baseline observations taken before surgery, during surgery, and in the
recovery area. When assessing patients recovery from anaesthesia and surgery, these
observation should not be considered isolation. The nurses should look at and feel the
patient. Many trusts now insist that vital signs are performed manually to provide more
accurate recording and assessment. The respiratory rate and function often the first vital
signs to be affected if there is a change in cardiac or neurological state. It is therefore
imperative that this observation is performed accurately. Nurses should observed and
record the following, airway, respiratory rate, and respiratory rate, and respiratory
depression, indicated by hypoventilation or bradypnea and whether opiate-induced or due
to anaesthetic gasses. Oxygen

is administered to enable the anaesthetic gasses to be

transported out of the body. The oxygen saturation should be above 95% on air; unless
the patient has lung disease; and maintained above 95%. Particular attention should be
paid to the systolic blood pressure as a lowered systolic reading and tachycardia may
indicate hemorrage and/or shock; although initially the blood pressure may not drop and

will remain within normal limits as the body compensates. Tachycardia may also
indicate that the patient is in pain has a fluid overload or is anxious. Hypertension can be
due to the anaesthetic or inadequate pain control. Patients who have been in the theatre
for a long period are at risk of hypothermia. Shivering can due to anaesthesia or a high
temperature indicative of an infection, while a drop in temperature might indicate a
bacterial infection or sepsis. Post-operative patients should respond to verbal stimulation,
be able to answer questions and be

aware

of

the

surroundings

before

being

transferred to the ward and throughout the post- operative period. A change in level of
consciousness can be a sign that the patient is in shock. The nurse should observe and
record on the fluid balance chart the nausea and vomiting, if necessary, administration of
antiemitics should be checked. The peripheral venous catheter are checked daily as a
minimum for signs of phlebitis redness, heat, and swelling. Patient can be discharged
quickly only when they do not experience any post- operative complications, may of
which can be avoided or identified with correct and thorough monitoring of signs and
symptom.
The Post Anaesthesia Care Unit must continually update their theoretical knowledge and
clinical skills, can do this by relying less on electronic equipment and developing their
ability to combine the use of assessment tools with good observational skills, feeling,
listening for abnormal sounds and closely observing the patient.
Recovery from anaesthesia can range from completely uncomplicated to lifethreatening. It must be managed by skilled medical and nursing personnel. The
Anaesthesiologist plays a key role in optimizing safe recovery from anaesthesia. Must
be carried out in a well- planned and protocol based fashion. The Post-Anaesthesia Care

Unit renders specialized care given to patients who have undergone anaesthetic
management by a team of well trained professionals, in a specially designed, equipped
and designated area of the hospital. Post-Anaesthesia Care Unit is provided to anyone
who has undergone anaesthesia and all patients who have undergone surgery.
The methods of anaesthesia have been available for more than 160 years the
Post-Anaesthesia Care Unit has only been common for the past 50 years but one can trace
it to Lady of the Lamp, Florence Nightingale. In 1920s and 1930s several PostAnaesthesia Care Unit opened in the United States and abroad. It was until after World
War II that the number of Post-Anaesthesia Care Unit increased significantly. This was
due to the shortage of nurses in the United States. In 1947, a study was released that over
an 11 year period, nearly half of the deaths that occurred during the 1st 24 hours after
surgery were preventable. In1949, having a Post-Anaesthesia Care unit was considered as
standard of care.
The Post-Anaesthesia Care Unit Staffing involved 1 nurse to 1 patient for the 1st
15 minutes of recovery and then 1 nurse for every 2 patients. The Anaesthesiologist is
responsible for the anaesthetic remains for managing the patient in the Post-Anaesthesia
Care Unit.
The Post-Anaesthesia Care Unit must be equipped with multi- parametric
monitors (automated blood pressure, pulse oximeter and ECG) and intravenous supports
should be located at each bed. The area for charting, bed-side supply storage, suction, and
oxygen flow meter at each bed-side. Supply of immediately available emergency
equipment, crash cart and defibrillator.

All the post- anaesthesia patients may it general anaesthesia, regional

anaesthesia or monitored anaesthesia care should receive Post-Anaesthesia assessment
and management. The patient should be transported to the Post-Anaesthesia Care Unit by
a member of the one anaesthesia care team that is knowledgeable about the patients
condition. Upon arrival in the Post-Anaesthesia Care Unit, the patient should be reevaluated and a verbal report should be provided to the nurse. The patient shall be
evaluated continually in the Post-Anaesthesia Care Unit. The Anaesthesiologist,
concerned is responsible for discharge of the patient.
CHAPTER III
RESEARCH METHODOLOGY
Research Method
This study is used a descriptive correlational survey method of research which
according to Calmorin (2008) determines the relationship between two variables (x) and
(y), if the relationship is perfect, very high, high, moderate, slight or negligible. In this
study the correlational survey method was used to determine the relationship between
assessments of nurses and doctors in Post-Anaesthesia Care Unit on the condition
patients four to eight hours after Video Assistant Thoracic Surgery based on Post
Anaesthesia Scoring Criteria.
Setting of the Study
Lung Center of the Philippines is a non-stock and non-profit corporation that was
established on January 16, 1981 by President Ferdinand E. Marcos under Presidential

Decree no. 1823. Philippine Government Tertiary Medical Center for Respiratory and
Thoracic Conditions, The Post Anaesthesia Care Unit has a sixteen bed capacity and the
nurse patient ratio is one nurse to patient for the first fifteen minutes of recovery and
one nurse for every two patients. It is a special area where surgical patients are afforded
comprehensive and critical care. The unit is equipped with continuous monitoring
device,

ventilators,

pipe

in

oxygen

and

suction

device, defibrillators,

resuscitation carts and emergency drugs, infusion pump and emerson pump, which will
designed to meet any emergencies in surgical cases. It is also provided with specialty
trained staff nurses and doctors for the effective delivery of such care.
Sampling Design
The respondents of the study are nurses and doctors with a total census
sampling of 20 patients all are in patients admitted in the post-anesthesia care unit in the
duration of study.
Respondents
The respondents in this study are the nurses and anesthesiologist who are assigned
in the Post-Anaesthesia Care Unit of Lung Center of the Philippines on the duration of
the study.
Research Instrument
The researchers used a modified questionnaire in gathering data for this study.
They modified the Discharge Criteria for Phase I & II Post Anaesthesia Care by the
Joint Standards of Post Anaesthesia Nursing Perspective (1991 2002) and Post-

Anaesthetic Discharged Scoring System to assess patient recovery and discharge after
colonoscopy by Lucio Trevisani, Viviana Cifala, et. Al (2013). For this study, a patient
should get a total score of 27 to be discharged from Post-Anaesthesia Care Unit.
Validation of the Instrument
The modified instrument was submitted to Ms. Glenda L. Picardal RN, MAN,
MM, MPA, PhD, for content validation. Their comments and suggestions were
considered before it was administered for pilot study which is .359 low reliability as
shown in Appendix B. The instrument was further analysed and improved through the
assistance of the research adviser and statistician. It

was

further

analysed

and

improved into a rubric form where criteria, condition delineation and indicators included.
The revised instrument having a reliability index of 0. 843 with a verbal description of
very high reliability as shown in Appendix B was in this study.
Data Gathering Procedure
Using the revised instruments, the researcher asked permission from the head of
Post Anaesthesia Care Unit to gather data from Post Anaesthesia Care Unit to the patient
who underwent Video Assisted Thoracic Surgery. The researchers requested the nurses
and doctors assigned/on duty on Post Anaesthesia Care Unit to use the instrument in
assessing the patients using their instruments. The filled-up instruments were then
collected and submitted to a statistician for data analysis. A letter of communication was
sent prior to distribution and collection of data and its takes two months to sum it up.

The following are guidelines to score the Post-Anaesthesia Scoring Criteria:

1. Muscle Activity
a) A score of 3 is assigned when the patient is able to move all the extremities on
command, or motor activity has returned to the patients pre-operative status (if a
deficit exist).
b) A score 2 is assigned when the patient is able to move only 3 extremeties.
c) A score of 1 is assigned when the patient is able to move only 2 extremeties.
d) A score of 3 must be achieved before discharge unless specified in writing by the
anaesthesiologist.
e) For patients with regional nerve block a score of 3 may be acceptable with a
discharge order by Anaesthesia.
2. Respiration
a) A point score of 3 is assigned when the patient is able to breathe deeply and
cough.
b) A point score of 2 is assigned when the patient exhibit signs of dyspnea or has
difficulty breathing and clearing secretions or requires supportive measures to
maintain airway patency.
c) A score of 1 is assigned when the patient is apneic or requires assisted ventilation.

d) A score of 3 must be achieved and maintained in this category for a minimum of

one-half hour before discharge.
3. Consciousness
a) A point score of 3 is assigned when the patient is fully awake, able to answer
questions and call assistance. If the patient had an altered level of consciousness
before surgery, the patient will receive a point score of 3 when he or she is at
preoperative consciousness level.
b) A point score of 2 is assigned when the patient is drowsy but respond easily to
verbal commands.
c) A point score of 1 is assigned when no response is elicited to verbal commands.
Painful stimulation is not employed to elicit a response.
d) The minimal score of 2 must be achieved in this category before discharge.
4. Circulation
a) Score of 3 is assigned when the blood pressure (systolic) reading is (+) or (-)
20mmHg the pre-anesthetic level.
b) A score of 2 is assigned when the blood pressure (systolic) reading is (+) or (-) 35
mmHg of the pre-anesthetic level.
c) A score of 1 is assigned when the blood pressure (systolic) reading is greater than
(+) or (-) 50mmHg of pre- anesthetic level.

d) Patients with a systolic blood pressure <90mmHg, or a systolic blood pressure

>200mmHg, or exhibiting a blood pressure other than

their

baseline pre-

anesthetic blood pressure, must be evaluated by an anesthesiologist prior to

discharge.
e) A minimum score of 2 must be achieved and maintained for at least three
consecutive readings at 15-minute intervals before discharge. The measurement
parameters defined in d must be met.
5. Oxygen Saturation
a) A score of 3 is assigned when the SpO2 meets or exceeds the anesthesiologists
parameters on room air.
b) A score of 2 is assigned when the SpO2 meets or exceeds the anesthesiologists
parameters on supplemental 02.
c) A score of 1 is assigned when the minimum Sp02 level as established by the
anesthesiologist cannot be maintained.
d) A score of 2 or higher must e achieved before discharge.
6. Heart Rate
a) A score of 3 is assigned when the heart rate is (+) or (-) 20 beats/ minute of the
pre-ansthetic level.
b) A score of 2 is assigned when the heart rate is (+) or (-) 40 beats /minut of the preanesthetic level.

c) A score of 1 is assigned when the heart rate is (+) or (-) 50 beats /minute of the
pre-anesthetic lvel.
d) Patients with a heart rate of <50beats/minute, >110beats /minute, or exhibiting a
cardiac rhythm other than their baseline pre-anesthetic rhythm must be evaluated
by an anesthesiologist prior to discharge.
e) A score of 2 or higher must be achieved and maintained for three consecutive
measurements at 15-minute intervals before discharge. The parameters defined
d must be met.
7. Pain
a) A score of 3 if pain is acceptable with the patient without pain medication..
b) A score of 2 if pain is controlled by opoid analgesic.
c) A score of 1 if pain is uncontrolled even with opoid analgesic.
8. Nausea and Vomiting
a) A score of 3 is assigned if minimal nausea and vomiting perceive by the patient
and without anti emetic medication.
b) A score of 2 is assigned if with moderate

relived with intravenous or

intramuscular medication.
c) A score of 1 is assigned if with severe nausea and vomiting and there is a
continuous repeated treatment.

9. Surgical Bleeding
a) A score of 3 is assigned if there is minimal bleeding. No dressing change required.
b) A score of 2 is assigned if there is moderate bleeding wherein dressing change up
2 times.
c) A score of 1 is assigned if there is severe bleeding and 3 or more dressing change
required.
10. Activity
a) A score of 3 is assigned when the patient is able to move all 4 extremities on
command, or motor activity has returned to the patients preoperative status (if
deficit exists).
b) A score of 2 is assigned when the patient is able to move only 3 extremities.
c) A score of 1 is assigned when the patient is able to move only 2 extremities.
d) A score of 3 must b achieved before discharge unless specified in writing by the
anesthesiologist.
e) For patients with regional nerve block, a score of 3 may be acceptable with
discharge order by Anesthesia.

Statistical Treatment of Data

Data were summarized using Microsoft Excel, analysed and interpreted using
Statistical Package for Social Sciences (SPSS) version 21.
To answer question 1and2, Weighted Mean and Frequency were used to determine the
Assessment of nurses on the condition of patients in Post-Anaesthesia Care Unit based
on Post Anaesthesia Scoring System four eight hours after Video Assisted Thoracic
Surgery.
To answer question 3, Pearson Product Moment of Correlation was used to determine
the significant correlation between assessments of nurses and doctors on the condition of
patients in Post-Anaesthesia Scoring System after Video Assisted Thoracic System.
Percentage Frequency Distribution
A percentage frequency distribution is a display of data that specifies the percentage of
observations that exist for each data point or grouping of data points. It is a particularly
useful method of expressing the relative frequency of survey responses and other data.
Many times, percentage frequency distribution s are displayed as tables or as bar graphs
or pie charts. The process of creating a percentage distribution involves first identifying
the total number of observation to be represented; then counting the total number of
observations within each data point or grouping of data points ;and then dividing the
number of observations within each data point of grouping of data point.

Formula

P= F x 100
N
Where:
P= percentage
F= frequency
N= Total number of Patient
Pearsons Product Moment of correlation
It is also known as the Product Moment Correlation Coefficient which is to be used
only in determining the strength of correlation between two or more interval data.
Formula
R p = dsdy
(n-1) (Sdx) (Sdy)

Where:
R p = Pearsons coefficient correlation
Edxdy = the sum of the product deviation of doctors and nurses variables
Sdx = Standard deviation of doctors
Sdy = Standard deviation of nurses

N = number of patieent
Where:
= Pearsons coefficient of correlation
= the sum of the product of the deviation of doctors and nurses variables
= standard deviation of doctors
= standard deviation of nurses
= number of patient

Computed r value

Interpretation

0.0 to +0.10

No correlation

+0.11 to +0.25

Negligible correlation

+0.26 to +0.50

Moderate correlation

+0.50 to +0.75

High correlation

+0.76 to +1.0

Cronsbachs Alpha

Very high perfect positive /negative correlation

If the response in the items are not scored high versus wrong as in some essay test where
more than one answer is possible to determine the internal consistency of the instrument
the alpha coefficient method should be used.It will be used only if the responses are not
continuous or non-dichotomous data. Further, coefficient alpha does not require the
assumption that all items are of equal difficulty although it is more difficult to calculate
computer programs for doing so are commonly available.
Formula:

Where;
K= the number of items in the tests
= the sum 0 variances of individual items
= the variances of scores on the test

CHAPTER 4
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter includes the presentation, analysis and interpretation of data gathered from
the patients by the nurses and doctors who perform the assessments. It comprises tabular
and textual presentations to facilitate the discussion and interpretation of the results.
Table 1
Assessment of Nurses on the Over-All Condition of Patients in PostAnaesthesia Care Unit Based on Post Anaesthesia Scoring System Four
Hours after Minor Operation

Score

Frequency Percent

22.00
23.00
24.00
26.00
27.00
28.00
29.00

2
1
2
1
10
2
2

10.0
5.0
10.0
5.0
50.0
10.0
10.0

Total

20

100.0

Table 1 show the assessment of nurses on the over-all condition of the patients in
Post-Anaesthesia Care Unit based on Post Anaesthesia Scoring System four hours after
minor operation. These reveal that first in rank is a score of 27 with 10 out of 20 (50%)
patients, second is 29, 28, 24 and 22 with 2 out of 20 (10%) patients each. All the
obtained scores are higher than the cut off score of 27 as shown.
Table 2

Assessment of Nurses on the Condition by Criteria of Patients in PostAnaesthesia Based on Post Anaesthesia Scoring System Four Hours after
Minor Operation
Criteria

Muscle
Activity

Condition
Delineation

Weighted
Mean

Heart Rate
Pain

17
3

3
17

0 0

2.15

Very
Good
Very
Good
Excellent
Very
Good
Very
Good
Very
Good
Good

Nausea &
Vomiting

13

0 0

2.35

Good

Surgical
Bleeding
Activity

15

0 0

2.75

19

0 0

2.05

Very
Good
Good

Weighted
Mean

12
.5

7.5 0 0

2.625

Respiration
Consciousness
Circulation
Oxygen
Saturation

0 0

2.80

Verbal Description

16
15

4
5

0 0

2.75

20
14

0
6

0 0
0 0

3.00
2.70

17

0 0

2.85

0 0

2.85

Legend: 1 1.49 Poor

Excellent

1.50 2.49 Good

Able to move 3-4 extremities

voluntarily on command
Able to breathe deeply; able to
cough freely
Fully awake
BP up to 20mmHg of preanaesthetic level
Meets or exceeds >92 % on
room air
Within 20 beats/min of Preoperative Baseline
Acceptable with the patient
with intravenous medication
Moderate
*(with intravenous and/or
intramuscular medications
Minimal * No dressing change
required
Able to ambulate with
assistance
*Steady gait but with dizziness
*Unsteady gait but no dizziness

Very
Good
2.50 2.99 Very Good

3.00

Table 2 on the other hand indicates the assessment of nurses on the condition of
patients of Post-Anaesthesia Care Unit by criteria indicated in the Post Anaesthesia
Scoring System four hours after Video Assisted Thoracic Surgery.
It reveals that the patients collectively got a weighted mean of 2.05 -3.0 from the
rating scales of 1-3 with a grand weighted mean of 2.62 meaning very good.
Consciousness got a perfect score of 3 meaning the patients are fully awake when they
were assessed four hours after minor operation. Both oxygen saturation and heart
rate got a weighted mean of 2.85 meaning very good which indicates that they meet or
exceed more than 92 % on room air and Within 20 beats/min of Pre-operative
Baseline respectively. In terms of muscle activity, patients got a weighted mean of 2.80
which signifies they were Able to move 3-4 extremities voluntarily on command
respiration. In terms of respiration and surgical bleeding, the group had a weighted mean
of 2.75 meaning very good because they were Able to breathe deeply and able to cough
freely and no dressing changed was required. In terms of circulation, they were very
good with a weighted mean of 2.70 meaning their BP was up to 20mmHg of preanaesthetic level. Patients were good in terms of pain (2.15) since they find pain
acceptable with intravenous medication, good in vomiting and nausea (2.35) since they
can do it with intravenous and/or intramuscular medications and good also in activity
since they were able to ambulate with assistance meaning its either they have Steady
gait but with dizziness, or Unsteady gait but no dizziness.

Table 3
Assessment of Nurses on the Over-All Condition of Patients in PostAnaesthesia Care Unit Based on Post Anaesthesia Scoring System Eight
Hours after Minor Operation

Score

Frequency

Percent

22.00

10.0

23.00

10.0

24.00

5.0

25.00

10.0

26.00

15.0

27.00

40.0

28.00

10.0

Total

20

100.0

Table 3 show the assessment of nurses on the over-all condition of the patients in
Post-Anaesthesia Care Unit based on Post Anaesthesia Scoring System eight hours after
minor operation. These reveal that first in rank is a score of 27 with 8 out of 20 (40%)
patients, second is 28 with 3 out of 20 (15%) patients, followed by 28, 25, 23 and 22
with 2 out of 20 (10%) patients each, and the last is 24 with only 1 out of 20 (5%)
patients. All the obtained scores are higher than the cut off score of ______ as shown.
Table 4
Assessment of Nurses on the Condition by Criteria of Patients in PostAnaesthesia Care Unit Based on Post Anaesthesia Scoring System Eight
Hours after Minor Operation
Criteria

Condition
Delineation

Muscle

16

Weighted
Mean
0 2.80

Verbal Description
Very

Able to move 3-4 extremities

Activity
Respiration
Consciousne
ss
Circulation
Oxygen
Saturation

voluntarily on command
Able to breathe deeply;
able to cough freely
Fully awake

13

0 2.65

19

0 2.95

13

0 2.65

16

0 2.80

0 2.85

0 2.15

Very
Good
Very
Good
Very
Good
Very
Good
Very
Good
Good

0 2.25

Good

0 2.60

0 2.00

Very
Good
Good

Heart Rate
Pain

17
3

Nausea &
Vomiting
Surgical
Bleeding
Activity

Over-All
Mean
Legend:
1 1.49 Poor
Excellent

Good

12
1

3
1
7
1
5
8
1
8

2.57

1.50 2.49

Good

BP up to 20mmHg of preanaesthetic level

Meets or exceeds >92 % on room
air
Within 20 beats/min of Preoperative Baseline
Acceptable with the patient with
intravenous medication
Moderate *(with intravenous
and/or Intramuscular medications
Minimal * No dressing change
required
Able to ambulate with assistance
*Steady gait but with dizziness
*Unsteady gait but no dizziness

Very
Good
2.50 2.99 Very Good

3.00

Table 4 on the other hand indicates the assessment of nurses on the condition of
patients of Post-Anaesthesia Care Unit by criteria indicated in the Post Anaesthesia
Scoring System four hours after minor operation. It reveals that the patients mutually got
a weighted mean of 2.05 -3.0 from the rating scales of 1-3 with a grand weighted mean of
2.57 meaning very good. Consciousness got the highest score with a weighted mean of
2.95 meaning the patients are fully awake when they were assessed four hours after
minor operation followed by heart rate with a weighted mean of 2.85 meaning patients
are within 20 beats/min of pre-operative baseline. Both oxygen saturation and

muscle activity got a weighted mean of 2.80 meaning very good which indicates that
they meet or exceed more than 92 % on room air and able to move 4 extremities
voluntarily on command respectively. In terms of respiration and circulation they
both got the weighted mean of 2.65 meaning very good since they are able to breathe
deeply and cough freely whose BP is up to 20mmHg of pre-anaesthetic level. Patients
were good in terms of pain with a waited mean of (2.15) since they find pain acceptable
with intravenous medication, good in vomiting and nausea with a waited mean of (2.25)
since they can do it with intravenous and/or intramuscular medications and good also in
activity with a waited mean of (2.00) since they were able to ambulate with assistance
meaning its either they have Steady gait but with dizziness, or Unsteady gait but no
dizziness.
Table 5
Assessment of Doctors on the Over-All Condition of Patients in PACU Based
on Post Anaesthesia Scoring System Eight Hours after Minor Operation
Frequency

Percent

25.00

20.0

26.00

35.0

27.00

40.0

28.00

5.0

Total

20

100.0

Table 5 show the assessment of doctors on the over-all condition of the patients in
Post-Anaesthesia Care Unit based on Post Anaesthesia Scoring System eight hours after
minor operation. These reveal that first in rank is a score of 27 with 8 out of 20 (40%)
patients, second is 26 with 7 out of 20 (35%) patients, followed by 24 with 4 out of 20

(20%) patients, and the last is 28 with only 1 out of 20 (5%) patients. All the obtained
scores are higher than the cut off score of ______ as shown.
Table 6
Assessment of Doctors on the Condition by Criteria of Patients in PostAnaesthesia Care Unit Based on Post Anaesthesia Scoring System Eight
Hours After Minor Operation

Criteria

Condition
Delineation
3
2
1

Muscle Activity

Verbal
Description

Weighted
Mean
2.95

Very Good

Verbal Description
Able to move 3-4
extremities voluntarily on
command
Able to breathe deeply;
able to cough freely
Fully awake
BP up to 20mmHg of preanaesthetic level
Meets or exceeds >92 %
on room air
Within 20 beats/min of
Pre-operative Baseline
Acceptable with the patient
with intravenous
medication
Moderate
*(with intravenous and/or
Intramuscular medications

19
17

1
3

2.85

Very Good

18
16

2
4

2.90
2.80

Very Good
Very Good

Circulation
Oxygen
Saturation

16

2.80

Very Good

2.70

Very Good

Heart Rate
Pain

14
7

6
13

2.35

Good

Nausea &
Vomiting

13

2.35

Good

Surgical
Bleeding

12

2.40

Good

Moderate
* Up to 2 dressing change
required

Activity

16

Good

Able to ambulate with

assistance
*Steady gait but with
dizziness
*Unsteady gait but no
dizziness

Respiration
Consciousness

Over-All

2.20

Legend:
1 1.49 Poor 1.50 2.49
Excellent

2.63

Good

Very Good

2.50 2.99 Very Good

3.00

Table 6 on the other hand indicates the assessment of doctors on the condition of
patients of Post-Anaesthesia Care Unit by criteria indicated in the Post Anaesthesia
Scoring System four hours after minor operation. It reveals that the patients mutually got
a weighted mean of 2.05 -3.0 from the rating scales of 1-3 with a grand weighted mean of
2.57 meaning very good. This is the ranking of the assessment of the doctors: First is
muscle activity with a weighted mean of 2.95 meaning the patients are able to move 3-4
extremities voluntarily on command. Second is consciousness with a weighted mean of
2.90 indicating that they are fully awake during assessment period. Third is respiration
with a weighted mean of 2.85 meaning they are able to breathe deeply and cough freely.
Next are circulation and oxygen saturation both with a weighted mean of 2.80 indicating
that their BP up to 20mmHg of pre-anaesthetic level and that they meet or exceed more
than 92 % on room air. It is followed by heart rate with a weighted mean of 2.70 which
means Within 20 beats/min of Pre-operative Baseline. The criteria with good ratings
are surgical bleeding (2.40), pain (2.30), nausea and vomiting (2.35) and activity (2.20).
These indicate that the patients required up to 2 dressing change, pain is Acceptable with
the patient with intravenous medication, nausea and vomiting is moderate with
intravenous and/or Intramuscular medications and they are able to ambulate with
assistance; either with steady gait but with dizziness or unsteady gait but no dizziness.
Table 7
Summary of Pearsons r- Coefficient of Correlation Test Result to Determine
the Significant Relationship Between the Nurses and Doctors Assessment on
the Condition of Patients in Post-Anaesthesia Care Unit

r- value

Verbal

p-value

Decision

Conclusion

0.532

Description
Moderate
relationship

0.016

0.05

Reject
Ho

There is a significant moderate

relationship between the nurses
and doctors assessment.

Table 7 shows the summary of Pearsons r- coefficient of correlation test result to

determine the significant relationship between the nurses and doctors assessment on the
condition of patients in Post-Anaesthesia Care Unit. The r- value = 0.532 indicates a
moderate relationship and the p-value 0.016 is lower than the set 0.05. Thus, the
null hypothesis is rejected. It means that there is a significant moderate relationship
between the assessments of nurses and doctors eight hours after a minor operation. It
reveals that the patients who received a high rating from the nurses are also the patients
who got high ratings from the doctors; although they did not give exactly the same
ratings.
CHAPTER 5
SUMMARY OF FINDINGS AND RECCOMENDATIONS
Summary of Findings
The study focused on developing Rubrics for Clinically-Based Objective
Scoring System which can be used by attending nurses in assessing the condition
of patients in Post-Anaesthesia Care Unit as a Post Anaesthesia Scoring System
from four to eight hours after minor operation. In establishing its validity and
reliability, the following data were obtained:
1. The patients utilize in this study as subject of the research are equally
distributed in terms of gender but mostly elderly in terms of age.
2. The nurses successfully used the Rubrics for Clinically-Based Objective
Scoring System as their instrument in assessing the condition of the patients
under study four-eight hours after Video Assisted Thoracic Surgery.

3. The doctors successfully used the Rubrics for Clinically-Based Objective

Scoring System as their instrument in assessing the condition of the patients
under study eight hours after Video Assisted Thoracic Surgery.
4. The research instrument, Rubrics for Clinically-Based Objective Scoring
System, is a reliable instrument in assessing the condition of the patients eight
hours after Video Assisted Thoracic Surgery. The tool was adopted from
Stanford Hospital and Clinics discharge criteria for Phase 1 and 2 Anaesthesia
Care.
5. There is a significant moderate correlation between the assessments of nurses
and doctors on the conditions of the patients under study eight hours after
Video Assisted Thoracic Surgery.
Conclusions
From the findings of the study, the following conclusions were made:
1. That the Rubrics for Clinically-Based Objective Scoring System, is a
reliable instrument in assessing the condition of the patients under study
eight hours after Video Assisted Thoracic Surgery.
2. That there is no significant difference on the assessments of nurses and
doctors on the condition of the patients under study eight hours after Video
Assisted Thoracic Surgery.
3. That the study offers insights on the researchers experiences as nurses
monitors patients condition from time to time in the post Anesthesia Care
Unit.
Recommendations
In the lights of the findings and conclusions of this study, the following
recommendations are being offered:

1. That the research instrument, Clinically-Based Objective Scoring

System, be used as a tool in assessing the condition of the patients
eight hours after Video Assisted Thoracic Surgery.
2. That the nurses assessment maybe considered as part of the
standardized procedure in discharging patients from Post-Anaesthesia
Care Unit who underwent Video Assisted Thoracic Surgery.
3. Future researchers may conduct a follow up study to improve the
validity and reliability of the instrument.

References:
1.Lucio Trevisani, Viviana Cifal, Giuseppe Gilli, Vincenzo Matarese, Angelo Zelante,
and Sergio Sartori. (2013) Post-Anaesthetic Discharge Scoring System to assess patient
recovery and discharge after colonoscopy. World Journal of Gastrointestinal Endoscopy
2.Laurentina Paler-Calmorin & Ma. Lauremelch Calmorin-Piedad. (2008) Nursing
3.Research. National Bookstore, Mandaluyong City
4. Statistics for research by Pablo E. Subong

5. Truong, LJL Moran and P.Blum, Post Anesthesia Care Unit Discharge, A clinical
Scoring System Versus Traditional Time Based Criteria. Anesthesia and Intensive 2004(page 33-42).
6. National Institute for Health and Clinical Excellence Acutely III Patients in
Hospital.Recognition of and Response of Acute Illness in Adult in Hospital 2007 London
(UK) Clinical Guideline No. 50 Retrieve on March 15, 2010.
7. Aldrete JAN and D.Kroulik -: A Post Aneasthetic Recovery Score , Anesthesia and
Analgesia 1970 pp924-934.
8.Aldrete JAN Modification to the Post Anesthesia Score Use in Ambulatory Surgery
Journal of Peri Anesthesia Nursing 1998 #13 pp 148-155.
9. Department of Health (2011) High Impact Intervention No. 2 ,Peripheral Intravenous
Cannula Care Bundle,London DH
10.Royale College of Nursing (2011)Standards for assessing, Measuring, and Monitoring
Vital Signs in Infants, Children, and Young People.London RCN,
11. Harvard Health Publications Harvard Medical School August 11,2014.
12. Use of a Modified Post anesthesia recovery score in phase II perianesthesia period of
ambulatory surgery patients. Lisa M. Saar Lt Nc Msn Cpom.

Appendix B

Reliability of the Instruments during Pilot Study

Cronbachs Alpha
0.359

No. of items
10

Interpretation: Low Reliability